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General NPI Number Information
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NPI Number | 1427472398
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Entity Type | Organization
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Legal Business Name | MAINE ENDODONTICS PA
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 221 EASTERN AVE
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City | AUGUSTA
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State | ME
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Zip | 04330-5930
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Country | US
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Telephone | 207-622-2500
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Fax | 207-623-3077
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Provider Business Mailing Address
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Address Line | 221 EASTERN AVE
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City | AUGUSTA
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State | ME
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Zip | 04330-5930
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Country | US
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Telephone | 207-622-2500
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Fax | 207-623-3077
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Authorized Official
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Title or Position | PESIDENT
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Name | DR. TERRY PAGE WYMAN
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Credential | DMD
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Telephone | 207-622-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2671
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License Number State | ME
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